House COVID-19 Healthcare Workgroup Recommendations
The House Healthcare Workgroup met on April 23 to review their draft bills in response to Covid-19. They developed a policy bill and a fiscal bill to cover the issues they wanted to address. Of the $688,555,000 million in the bill, $480,150,100 comes from the Federal Coronavirus Relief Fund and the remaining $208,400,000 come from Medicaid receipts as a result of the FMAP increase.
Members were able to put forward amendments, most technical in nature, that were passed and included in the bill. The committee did a roll call vote via videoconference and passed both the policy and fiscal bill.
The bills will be introduced on April 28th when session begins. On April 29th, the policy bill will be sent to the HHS Oversight Committee and the fiscal bill will be sent to the Appropriations committee. Both bills will be heard in their respective committees on April 29th. The current plan is that all the separate COVID-19 workgroup (Education, Healthcare, State Operations, Economic) bills will be rolled into one omnibus bill that the House can vote on in person at the General Assembly on April 30th.
If the COVID-19 House omnibus bill passes the House, it will then need to go before the Senate for a vote. At this time, the Senate has not held any public meetings concerning COVID-19 but the Senate Democrats have released some internal discussions they have been having which mirror much of what we have seen come out of the House COVID-19 workgroups. We are hopeful that the Senate will be reasonably aligned with the House recommendations so that a compromise bill can be established quickly and passed.
Section 3.1:
State Plan for a Strategic State Stockpile of Personal Protective Equipment and Testing Supplies for Public Health Emergencies
Section 3.1(a) would establish definitions for "acute care providers," "first responders," "health care providers," "long-term care providers," and "non-health care entities."
Section 3.1(b) would direct the Division of Public Health (DPH) and the Division of Health Service Regulation (DHSR), in conjunction with the North Carolina Division of Emergency Management to develop a plan for creating and maintaining a strategic state stockpile of personal protective equipment (PPE) and testing supplies. This plan must be submitted to the Joint Legislative Oversight Committee on Health and Human Services and the Joint Legislative Oversight Committee on Justice and Public Safety.
Section 4.6:
Pandemic Health Care Workforce Study Section
4.6 (a), (b), (c), (d), and (e) would charge the North Carolina Area Health Education Center (NC AHEC) with studying the issues that impact health care delivery and the health care workforce during a pandemic, including issues that need to be addressed in the aftermath of this pandemic and plans that should be implemented in the event of a future health crisis. Input must be solicited from all relevant stakeholders.
Section 5.3:
Provide Medicaid Coverage for COVID-19 Testing to Uninsured Individuals in North Carolina During the Nationwide Public Health Emergency Section
5.3 would authorize DHHS to provide Medicaid coverage for COVID-19 testing for the uninsured during the nationwide coronavirus public health emergency as allowed under the Families First Coronavirus Response Act. The coverage may be retroactive to the extent allowed.
Section 5.4:
Temporary Medicaid Coverage for the Prevention, Testing, and Treatment of COVID19
Section 5.4 (a) and (b) would authorize DHHS to provide temporary, targeted Medicaid coverage to individuals with incomes up to 200% of the federal poverty level, as described in the 1115 waiver request Draft Page 6 that DHHS submitted for federal approval. Coverage for this group cannot exceed coverage of services for the prevention, testing, and treatment of COVID-19, and must be for a limited time period related to the nationwide coronavirus public health emergency. The coverage may be retroactive to the extent allowed.
Section 5.6:
Disabled Adult Child Passalong Eligibility/Medicaid
Section 5.6 would eliminate the requirement that an individual must have received a Supplemental Security Income (SSI) payment to qualify for the Disabled Adult Child passalong in the Medicaid program, no later than June 1, 2020.
Section 5.7:
Modification of Facility Inspections and Training to Address Infection Control Measures for COVID-19
Section 5.7(a) would instruct the Department of Health and Human Services, Division of Health Service Regulation (DHSR), and local departments of social services to suspend all annual inspections, regular monitoring requirements, and adopted rules for licensed facilities for persons with disabilities or substance use disorders, and for adult care homes. Annual inspections, regular monitoring requirements, or adopted rules deemed necessary by DHSR to avoid serious injury or death, or as directed by CMS, would not be suspended.
Section 5.7(b) would require DHSR to review the compliance history of facilities found to be in violation, assessed penalties, or placed on probation within the six-month period preceding the beginning of the COVID-19 emergency for noncompliance with rules or CDC guidelines regarding infection control or the proper use of personal protective equipment. Employees of these facilities must undergo immediate training, permissible by video conference, about infection control and the proper use of personal protective equipment
Section 5.7 would become effective when it becomes law and expire 60 days after Executive Order 116 is rescinded or December 31, 2020, whichever is earlier.
Section 6.1: Expanded Use of Telehealth to Conduct First and Second Involuntary Commitment Examinations
During the COVID-19 Emergency Under current law, individuals taken into custody for involuntary commitment must have a first examination conducted by a commitment examiner without unnecessary delay. There is no provision for this examination to be conducted via telehealth, except in cases where geographic distance is an issue. A second examination must be conducted within 24 hours of the first examination. Section
6.1(a) would establish definitions for "Commitment examiner," "Telehealth," and "Qualified professional."
Section 6.1(b) and (c) would allow the first and second examinations, respectively, to be conducted via telehealth, provided that the commitment examiner is reasonably certain that a different result would not have been reached in a face-to-face examination.
Section 6.1 would become effective when it becomes law and expire 60 days after Executive Order 116 is rescinded or December 31, 2020, whichever is earlier.
Section 6.2: Health Benefit Plan Coverage of Telehealth Section
6.2(a) would add a new section to Article 50 of Chapter 58 that would define "health benefit plan," "telehealth," and "virtual healthcare" and require insurers and the State Health Plan to:
* Provide coverage for telephonic healthcare and electronic patient visits, both of which would be considered virtual healthcare.
* Provide coverage for provider-to-provider consultations conducted via virtual healthcare if those consultations would have been covered if they had been face-to-face.
* Cover telehealth and virtual healthcare services without prior authorization or any limits on the originating or distant sites.
* Cover physical therapy, occupational therapy, and speech therapy when delivered via telehealth.
* Not charge a greater deductible, copay, or coinsurance for services delivered via telehealth than is required for in-person services.
* Reimburse providers the same rate for telehealth services as they do for in-person services.
Section 6.2 would become effective when it becomes law and expire 60 days after Executive Order 116 is rescinded or December 31, 2020, whichever is earlier.
The coverage required by section 6.2 would only be effective from (i) March 10, 2020, through the date Executive Order 116 expires or is rescinded, and (ii) the day any subsequent state of emergency is declared in response to the COVID-19 pandemic during the 2020 calendar year through 30 days after that subsequent state of emergency is rescinded.
A
liability protection amendment
was passed and included in the bill. The hospital association and some other health associations worked on the amendment. We have asked a couple of attorneys to review it to see where there are gaps in protections for our members that we could potentially address through an amendment next week when the bill is heard in committee.
Section 2.2:
Enhanced Behavioral Health Capacity Section
2.2 would appropriate $25 million in nonrecurring funds received from the Coronavirus Relief Fund to DHHS to support behavioral health and crisis services to respond to COVID-19. At a minimum, funds must be used to divert individuals experiencing behavioral health emergencies from emergency departments, and to allocate $12,600,000 in nonrecurring funds, distributed as a one-time payment, to each local management entity/managed care organization (LME/MCO) to be used to provide temporary additional funding assistance for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IDD) services.
Section 3.1:
Funds for Additional Medicaid Costs Section
3.1 would appropriate $40 million in nonrecurring funds received from the Coronavirus Relief Fund to be used for additional Medicaid costs related to the COVID-19 pandemic, including: (i) costs for additional provider support for long-term care, primary care, and other providers at risk of insolvency due to disrupted revenue; (ii) costs for COVID-19 testing and treatment; and (iii) costs associated with increased enrollment in Medicaid.
Section 3.2: Medicaid Provider Rate Increases
Section 3.2 would require DHHS to provide a 5% increase in the Medicaid fee-for-service rates paid to all provider types by the Division of Health Benefits. The rate increase will be effective March 1, 2020, through the duration of the nationwide coronavirus public health emergency.
Section 3.5:
Implement Temporary Provider Enrollment Changes Authorized Under the Medicaid 1135 Waiver Section
3.5 would specify that certain provisions of State law pertaining to provider enrollment shall not apply to the Medicaid and Health Choice programs from March 1, 2020, through the duration of the nationwide coronavirus public health emergency, in order to implement temporary provider enrollment authorized under the recently-approved Medicaid 1135 waiver.
The provisions are as follows:
* G.S. 108C-2.1, which requires a $100 fee for provider enrollment applications and requires recredentialing every five years.
* G.S. 108C-4(a), which imposes a State requirement to conduct criminal history record checks.
* G.S. 108C-9(a) and (c), which requires providers to complete certain trainings prior to initial enrollment as a Medicaid and Health Choice provider.
Section 4.1:
Funds to Increase the State's Supply of Personal Protective Equipment and Other Equipment and Supplies to Respond to COVID-19
Section 4.1(a), (b), and (c) would appropriate $50 million in nonrecurring funds received from the Coronavirus Relief Fund to the Office of State Budget and Management (OSBM) for allocation to DHHS and the Division of Emergency Management (DEM), Department of Public Safety, to be used to:
(1) purchase personal protective equipment (PPE) that meets CDC guidelines for infection control;
(2) purchase other supplies and equipment related to emergency protective measures to address immediate threats to life, public health, and safety related to COVID-19 (such as ventilators, touch-free thermometers, disinfectant, and sanitizing wipes); and
(3) meet State match requirements for Federal Emergency Management act (FEMA) public assistance funds for the COVID-19 pandemic.
Any supplies and equipment purchased with these funds may be made available to both public and private health care providers and other entities that DHHS or DEM deem essential to the COVID-19 response.
Section 5.1:
Funds for Testing, Contact Tracing, and Trends Tracking Analysis
Section 5.1 would appropriate $25 million in nonrecurring funds received from the Coronavirus Relief Fund to DHHS to expand public and private COVID-19 testing, contact tracing, and trends tracking and analysis including
(1) building capacity for widespread COVID-19 diagnostic testing to enable rapid case-based interventions;
(2) building capacity for antibody testing to enable rapid deployment when such testing becomes available;
(3) expanding contact tracing workforce and infrastructure to routinely identify potentially exposed persons and take appropriate public health actions;
(4) increasing research and data tools and analysis infrastructure to support better predictive models, surveillance and response strategies.
Section 6.1:
Funding for Various Responses Related to Food, Safety, Shelter, and Child Care Section
6.1(a) would appropriate $25 million in nonrecurring funds received from the Coronavirus Relief Fund to DHHS to provide funding for adult and child protective services response, support for homeless and domestic violence shelters and housing security, child care response, and technology modifications to support COVID-19 emergency relief beneficiaries. Section 6.1(b) would allocate $6,000,000 of those funds, distributed equally, to each of the six food banks in the State.
Section 6.2:
Supplemental Payments for Foster Care Section
6.2 would appropriate $2,250,000 in nonrecurring funds received from the Coronavirus Relief Fund to the Department of Health and Human Services, Division of Social Services, to be used for monthly $100 supplement payments for each child receiving foster care assistance payments for the months of April, May, and June 2020.
Section 6.3:
One-Time Financial Assistance for Facilities Licensed to Accept State-County Special Assistance Section
6.3(a) would establish definitions for "facility licensed to accept State-County Special Assistance payments or facility" and "State-County Special Assistance".
Section 6.3(b) would appropriate $25 million in nonrecurring funds received from the Coronavirus Relief Fund to the Department of Health and Human Services, Division of Social Services, for a one-time payment to facilities licensed to accept State-County Special Assistance (SA). Each eligible facility will receive $1,325 per resident of the facility who is a SA recipient between March 10, 2020 through July 30, 2020, to offset the costs of serving these residents during the COVID-19 emergency. If a recipient is transferred to another facility during this time frame, only the first eligible facility will receive payment. Section 6.3(c) would clarify the General Assembly does not have an obligation to appropriate funds, nor is there an entitlement by any facility or resident of a facility to receive financial assistance.
Section 7.1:
Funds for Underserved Communities and Rural Hospitals Section
7.1 would appropriate $25 million in nonrecurring funds received from the Coronavirus Relief Fund to DHHS to provide funds to support rural and underserved communities. These funds may be used for directed grants to health care providers other than rural hospitals; targeted Medicaid assistance for rural providers; enhanced telehealth services; transportation for critical services; health care security for the uninsured; and other related purposes.
PART IX. FUNDS FOR COVID-19 RESEARCH
Section 9.1: COVID-19 Response Research Fund Section 9.1(a) would appropriate $110 million in nonrecurring funds received from the Coronavirus Relief Fund to OSBM to establish the COVID-19 Response Research Fund. OSBM would allocate $100 million to the North Carolina Policy Collaboratory (Collaboratory) at the University of North Carolina at Chapel Hill.
Funds would be provided to the following entities to be used for (i) the rapid development of a countermeasure of neutralizing antibodies for COVID-19 that can be used as soon as possible to both prevent infection, and for those infected, treat infection, (ii) for bringing a safe and effective COVID-19 vaccine to the public as soon as possible, (iii) community testing initiatives, (iv) and other research related to COVID-19:
* $25 million to the Duke University Human Vaccine Institute (DHVI) of the Duke University School of Medicine;
* $25 million to the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill;
* $25 million to the Brody School of Medicine at East Carolina University;
* $25 million to the Wake Forest School of Medicine. $10 million would be allocated to the Campbell University School of Osteopathic Medicine for a community and rural-focused primary care workforce response to COVID-19.
House Continuity of State Operations
While most items in the bill that this workgroup passed did not have a direct impact on our industry, it did include changes to the involuntary commitment process. The changes
would permit the administration of involuntary commitment cases with less face-to-face contact by authorizing the use of telemedicine for some statutorily required examinations and recommendations. This change would become effective when it becomes law and expire August 1, 2020.
You can see the all the details of this change in section 15 of the
full bill
located on page 15.
Effective April 20, 2020, NC Medicaid in partnership with the DHHS Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSAS), is temporarily modifying its
Behavioral Health and Intellectual and Developmental Disability Clinical Coverage Policy
8C: Outpatient Behavioral Health Services Provided by Direct-Enrolled Providers to better enable the delivery of care to NC Medicaid, NC Health Choice and State-funded individuals in response to the COVID-19 Pandemic.
In addition to previous flexibilities published in
COVID-19 Special Medicaid Bulletins
#9, #19, and #46, the Department is issuing guidance on allowing telephonic outpatient psychotherapy, in addition to the telehealth flexibilities previously added. As clinically appropriate, services may still be offered via HIPAA-compliant, real-time, two-way interactive audio and video telehealth appointment to proceed with the behavioral health intervention(s). (Note: please see OCR guidance relaxing technology requirements). If that option is not available, services may be offered via non-HIPAA compliant audio and video telehealth appointment with documented beneficiary or legal guardian consent. If two-way audio-visual options are not accessible to the beneficiary, the following services may be offered via telephonic modality.
These temporary changes are retroactive to March 10, 2020, and will end the earlier of the cancellation of the North Carolina state of emergency declaration or when the policy modification is rescinded. When the temporary modifications end, all prior service requirements will resume.
NC Medicaid has received federal approval of flexibilities during the COVID-19 pandemic for the following home and community-based services:
- NC Innovations Waiver, for individuals with intellectual and developmental disabilities (IDD)
- NC Traumatic Brain Injury (TBI) Waiver, for individuals who have a TBI diagnosis after age of 21
- Community Alternatives Program for Disabled Adults (CAP/DA), for disabled adults
- Community Alternatives Program for Children (CAP/C), for medically fragile children
- Temporary flexibilities include telephonic contact with beneficiaries, providing services in alternative settings, a simplified person-centered plan development, and changes that ease requirements on service levels. For details, please see Special Bulletin COVID-19 #55.
Flexibilities are effective March 13, 2020, to March 12, 2021, the end of the public health emergency, or when the State determines the flexibilities are no longer necessary, whichever is first.
This waiver offers the removal of certain dollar and stay limits, expanding the type of location where services can be delivered and easing requirements for reviews of personalized care plans and in-person meetings. Temporary modifications to waiver services and requirements will be made on an individual basis.
Child Welfare Responses to COVID-19
Last Friday, NC DSS provided multiple webinars for both county DSS agencies and private providers about the waivers they were implementing as a result of federal waiver allowances and in response to the Governor's Executive Order # 130 released on April 8th. Along with the webinars, they provided a
Dear County Director and Executive Directors of Private Licensed Child Placing Agencies
letter and new waiver forms:
- Conduct all available name-based criminal background checks for prospective foster parents, adoptive parents, legal guardians, and adults working in child care institutions, and
- Complete the fingerprint-based checks of NCID pursuant to ยง471(a)(20)(A), (C), and (D) of the Act as soon as it can safely do so, in situations where only name-based checks were completed.
The letter also allows waivers around social worker required home visits. Federal regulation requires that each state must ensure that not less than 50 percent of the total number of monthly caseworker visits during a federal fiscal year occur in the residence of the child. The Children's Bureau will allow a modification to this requirement that recognizes monthly caseworker visits that occur by means of video conferencing as meeting this requirement.
NC DSS plans on providing guidance around these allowable changes sometime next week.
We hope NC DSS will have guidance issued around both of these federal bulletins next week as well.
FFPSA Preparation
The dates for states to implement FFPSA have not changed at this time, despite the interference due to COVID-19. The Leadership Advisory Team met on Wednesday of this week to discuss the work of 2 ad hoc committees.
One of these committees is developing the NC Proposed Prevention Services. To see the current working draft click on
NC Proposed EBP Worksheet Draft
.
The last page (page 18) of the document has a consolidated spreadsheet of the interventions needed by service type within the three categories that FFPSA has designated of Well-Supported, Supported and Promising.
Please take a few moments to look through the interventions currently listed and let us know of any key services you think should be added to the list.
The other ad hoc committee is developing definition of what children will be considered "candidates" for the prevention services being identified by the ad hoc group developing the proposed prevention services noted above. NC DSS has developed a draft definition and wants to gradually expand the definition of "candidate" through a 3 phase process noted in the
Candidacy Decision Memo.
NC DSS hopes to complete the plan for the prevention services it will adopt and the candidacy definition by June. We will continue to update you on the progress of this work and we very much need your feedback for each of them.
